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` APPLICATION FOR -SANITATION PERMIT Permit No. ___.....�-0--.!e. "(Complete inDupl�ca e)9 Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. f JOB ADDRESS AVP LOCATION--- ------?------ -- -------- ----- ---- -------------------------- ZI Owner's Name --/� ----- ---------- -----=----------- ------------------------------------------------- - --------------------------------------- -- Phone------------- ------ Address---------LP I! r ,. ----------------•--•-- -----------•-- --------___-- --- ---------- Contractor's Name__-._-_1�f:...."� --------------x... --------------------------------- '~----- --------------•-------------------- Phone------------------------------ ... Installation will serve: Residence. Apartment House ❑ Commercial ❑ Trailer Court [❑ Motel ❑ Othe ❑ f ' Number of living units- t_�____ Number of bedrooms I---- Number of baths �!_____ Lot size_________ _______ _ ____ _ _��_,/00 Water Supply: PublicsystemCcmmun'ity�system-❑- Private'0 Depth tolWater Table Character of soil to a depth of 3 feet: Sand, Gravel ❑ Sandy Loam Clay Lbam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Const uction" Yes, V,,� ❑ FHA/VA: Yes ❑ No TYPE.OF INSTALLATION AND SPECIFI ATIONS:- - (No septic tank or'cesspool_pi' itfe if' bjic sower is available within 201 feet.) x t .. n Septic nk: '- Distance from neare sr`w�elf�_�istan fro foupl�tio _e _ Mater a�_______ No oRf~compartrr�ents_ _-•--- �,r--;-- +--- ize -------- ,-----Liquid depth- -j--- '-------�, iCapacity...._ Dispos Field: Distance from ea rest ell 5__..:____Distance from foundation ,_ Distance to nearest lot line � ! �- Number of li+es__-------- ength of.each line________'-.�- Width of trench___-r_____It-_ Type of filters ate�i __1 th of filter material- ------ - -------Total leng - ----- ---. --_- Seepage Pit: Distance to nearest..w II_ _ ___ istance from oundation____________________Distance to nearest lot line____.____________ -10�❑ Number of pits;T i_'-� _-Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- Distance -------------------- --- ( � , Cesspool: Distance:from Barest tll_______________ _Distance from foundation-_____________.____,Lining material__.______.-_____._..______________ Size: Diameter __ ._De th_________________________ Liquid Capacity i a ❑ t Di - p ----- --------- q .. P Y gals. .+Privy: Distance from nearest well,_______,____-_--------------------------------Distance from nearest•building_'__,------------------------------------ f , y ❑. Distanceto nearest_ lotHine--------------------------------------------------------------- ----------------- -- ------------------ ------ RemA in nd/o repairing de;.srr .` ------ ----'--------------------------------------------------------------------•-----------------------------------•-------------_---•- -- -- --- --:--------- --- - ----•------- -------- Zll ------------------------------•-----------•---------------------------•-- ---------------------------•------•-------------------------------------------------------------------- -------------------------- --------------------------------------------------------__4------------------------------..----------------------------------------------------------------------------------------------------------------------- ---------- I hereby certify that I have}7repared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules-and regulations of the San Joaquin Local Health District. "�`••�� 101 (5igned) �! h --_ - ________________(Owner and/or Contractor) " , (Plot plan, showing-size' of lot, location of system in relation fo wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY- -- ------ -•------ ---------------- --=------------------------------•-------. -------------- DATE—,: .....---------- ---------------•--------------- REVIEWEDBY------------------------------- ----- --- -------------------------------------------------------=--•--•-------------- DATE-_ ------------- BUILDING PERMIT ISSUED-------------------`---------------------------R-------=----—-------------------------------------- DATE----_-+t--.------------------------------------------ -- Alferafions and/or recommendations------------------------------------------------------------=-----------------------------------•-----•----------------•-----------------------------------' i ---------------------------------•-----------------------------------------------------------------------------------------------------------------------i-•----:------•--------•-•---------------•---------------------•---•- ---------------------------------•-------------------------•-----------------------------------------------------------•--------------------------------- ------------•---------- -•-------------•------------••-------------- ------------------------------------- FINAL INSPECTION BY:_ '. "=� Date----- tr-1:------------------------------------------------------------ - SAN --------- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT Y 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M , Revised 1-57 F.P.CO-